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poly sensitised groups. This might be because of the different designs of the included studies. For example, the changes in nasal symptom score were the smallest in the study of Soyyigit (24), in which the treatment duration of AIT was the shortest among the studies. In addition, the study of Cui (27) showed the greatest changes in nasal symptom score, which might be caused by the different evaluation tools: CSMS. Because CSMS reflects medication and nasal symptom scores simultaneously, the changes in this value might be greater than the changes in other values such as TNSS. Eight studies (21-23,25-29) reported comparable improvement in nasal symptom score after HDM AIT in monosensitised and polysensitised patients, and one study (28) reported greater clinical improvement in polysensitised patients than in monosensitised patients. Tu (28) demonstrated a greater improvement in the polysensitised group than in the monosensitised group; the baseline nasal symptom score was higher in polysensitised patients than in monosensitised patients. In the pooled analysis of nine studies, there was a significant decrease in the nasal symptom score in both groups; however, the changes were not significantly different between the two groups. A sensitivity analysis omitting three studies (24,25,28) was performed to evaluate the effect of a potential confounding bias due to the difference in the baseline nasal symptom score between the two groups. However, the changes in nasal symptom score did not significantly differ between the two groups, which is consistent with the findings of pooled analysis including all studies. In addition, a sensitivity analysis omitting each study in turn revealed no significant differences between the two groups. The pooled analysis and sensitivity analysis found that the clinical effectiveness of HDM AIT in nasal symptom was comparable in monosensitised and polysensitised patients. One study compared the clinical effectiveness of HDM AIT between monosensitised and polysensitised groups with control groups; however, the inclusion criteria were not satisfied and the data for pooling were not extractable (43). In the study of Nolte (43), average total combined rhinitis symptom score improved by 17% and 18% compared to placebo groups in monosensitised and polysensitised groups, respectively. This was consistent our findings, which indicate comparable clinical effectiveness in monosensitised and polysensitised patients. Five out of nine included studies (21,23,24,26,29) assessed the clinical effectiveness in medication score in monosensitised and polysensitised patients. Four (21,23,26,29) out of the five studies reported a significant improvement in medication score in the both groups; however, one study (24) did not show a significant improvement in the both groups. In comparison of the clinical effectiveness in medication score between monosensitised and polysensitised patients, three studies (21,23,24,26) demonstrated a comparable decrease in medication score between monosensitised and polysensitised patients; however, one study (29) did not report whether a significant difference between monosensitised and polysensitised patients was present. In the pooled analysis, the changes in medication scores were comparable between the two groups. Three out of nine studies evaluated the clinical improvement in Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) score between monosensitised and polysensitised patients. Two (25,26) out of the three studies demonstrated a significant improvement in RQLQ in the both groups. However, one study (24) did not clearly demonstrate whether the improvement of RQLQ score was significant in the both groups. In comparison of the improvement in
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